Mamekhaya: a pilot study combining a cognitive-behavioral intervention and mentor mothers with PMTCT services in South Africa

Abstract

Nearly 30% of pregnant women in South Africa are estimated to be HIV seropositive, yet adherence to guidelines for the prevention of mother-to-child transmission of HIV (PMTCT) is often low. A pilot study was developed to see whether PMTCT services provided by the South African government could be enhanced by the Mamekhaya program, a combination of the mothers2mothers (M2M) peer-mentoring program and a culturally adapted cognitive-behavioral intervention (CBI) from the United States. Pregnant women attending two maternity clinics offering PMTCT in Gugulethu and Vanguard Townships, Cape Town, South Africa, were invited to participate in the study. Women at the intervention site (Gugulethu) received the support of a mentor mother and also attended an eight-session Mamekhaya CBI. At the control site (Vanguard), women received standard services provided by midwives and counselors. Baseline assessments were completed by all participants at enrollment (n = 160), and follow-ups were completed six months later by 44% of participants. Self-reports of adherence to PMTCT practices were high across both sites (90% or more engaging in the core practices). Women at the Mamekhaya site showed significantly greater improvement in establishing social support and reducing depression scores than women at the control site. Mamekhaya participants also showed trends for better attendance at follow-up medical visits, and greater improvements in positive coping. The greatest effect of the Mamekhaya program was to increase HIV knowledge scores, particularly with regard to understanding the meaning and importance of viral load and CD4 test results. Results from this pilot study show promise that augmenting basic PMTCT services with mentor mothers and a culturally adapted CBI can be effective in conveying information and in improving the emotional outlook and hopefulness of HIV-positive pregnant women in South Africa.

Randomized controlled trial evaluating the effect of an interactive group counseling intervention for HIV-positive women on prenatal depression and disclosure of HIV status

“…Although Futterman et al (2010) observed a reduction in depressive symptoms among those enrolled in their counseling intervention, findings from another support group intervention did not result in a lower level of depression, but did improve disclosure rates in South Africa (Mundell et al, 2011). To our knowledge, there have been no reported randomized controlled trials in resource-limited settings examining interventions to reduce the burden of depression and/or increase HIV disclosure among HIV-positive pregnant women.…”

“…A number of observational studies have examined the association between a counseling intervention and depression and/or disclosure among HIV-positive pregnant women in similar settings (Futterman et al, 2010;Mundell et al, 2011). Although Futterman et al (2010) observed a reduction in depressive symptoms among those enrolled in their counseling intervention, findings from another support group intervention did not result in a lower level of depression, but did improve disclosure rates in South Africa (Mundell et al, 2011).…”

Current Knowledge and Future Research on Infant Feeding in the Context of HIV: Basic, Clinical, Behavioral, and Programmatic Perspectives

“…Futterman et al (171) concluded that in a South African program deploying peer mentor mothers, medical follow-up visits to the PMTCT clinic increased as did knowledge about PMTCT. In India, the introduction of peer counselors resulted in a 6-fold increase in the percentage of HIV-positive women referred for care and more than doubled the institutional delivery rates (133).…”

Suporte social de gestantes com HIV: revisão narrativa

“…Quanto à categoria suporte social emocional, observaram-se como fontes a família, 12,14,15,24,25,[27][28][29] o companheiro, 10,22,26 os amigos 15,24,27 e a crença em Deus e a fé, 15,24,27 como estímulos para continuidade do tratamento. Fica explícito que as questões culturais e familiares influenciaram nas decisões em relação aos cuidados de saúde maternos e infantis.…”

“…Conforme os estudos, 12,14,25,28 as gestantes acreditavam que os familiares apresentavam opiniões e percepções negativas acerca das pessoas com HIV, o que poderia gerar estigma e discriminação.…”